title: A case where rocuronium was unable to achieve neuromuscular block immediately after sugammadex administration.
abstract: We present a case where immediate muscle relaxation was needed following sugammadex administration. A 72 year-old female underwent surgery for a cerebral artery aneurysm. Upon conclusion of the operation sugammadex (9.3 mg/kg) was administered and the patient was noted to have left hemiplegia. Rocuronium (1.2 mg/kg × 2 doses) was given in order to gain neuromuscular block approximately 25 minutes after sugammadex had been injected. Although TOF monitoring was not utilized in this case and assessing residual muscular block was difficult, spontaneous respirations continued and breathing had to be controlled with sevoflurane and remifentanil. Sugammadex is a potent reversal agent for rocuronium-induced neuromuscular block, however, certain situations require immediate neuromuscular blockade following sugammadex. In this case, rocuronium was unable to induce neuromuscular blockade immediately after sugammadex and that higher concentrations were necessary in addition to intravenous analgesics and inhaled anesthetics.
authors.affiliation: Department of Anesthesiology, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Sakai
authors.forename: Yasuo M
authors.initials: YM
authors.lastname: Tsutsumi
authors.forename: Narutomo
authors.initials: N
authors.lastname: Wakamatsu
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Soga
authors.forename: Katsuya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Shuzo
authors.initials: S
authors.lastname: Oshita
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000732:Androstanols / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008738:Methyl Ethers / Q000008:administration & dosage; D009126:Muscle Relaxation / Q000187:drug effects; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D000077123:Rocuronium; D000077149:Sevoflurane; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D000732:Androstanols; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077149:Sevoflurane; D000077208:Remifentanil; D000077123:Rocuronium